1. Field of the Invention
The present invention relates to retractors for use during surgery and, more particularly, for use in retracting ribs and adjacent tissue during surgery of the thorax.
2. Description of Related Art
During surgery it is frequently necessary to retract tissue, bone or other body material in order to facilitate access to and visualization of the surgical site. This is particularly true in surgery of the thorax. If access to the chest cavity is sought between the ribs, both the chest wall tissue and the ribs must be retracted to provide an opening large enough for insertion of surgical instruments and to allow visualization of the chest cavity, either directly through the incision or through an endoscope, microscope or other visualization device. In certain surgical procedures, such as coronary bypass grafting, it may be desirable to both lift the chest wall anteriorly and spread the ribs superiorly and inferiorly, for example, to harvest one or both of the internal mammary arteries located on the interior of the chest wall. During the same surgical procedure, it may be desirable, in addition to lifting and spreading the ribs, to only spread the ribs, depending upon the surgical manipulations to be performed.
Although many surgical retractor designs have been proposed, there remains a need in the art for a retractor that is able to perform various functions while having minimum size, few parts, and high ease of use.
A surgical retractor constructed according to the invention comprises a frame and first and second retractor blades coupled to the frame, the retractor blades having retraction surfaces configured to engage an incision in a patient""s body. The first and second retractor blades are relatively movable toward or away from each other along a first axis to position the blades closer to or farther away from each other. A foot is coupled to the frame or one of the blades and has a support surface configured to engage a surface of the patient""s body adjacent the incision. An actuator is provided for imparting relative movement to the retractor blades along the first axis. The foot acts as a support base and one of the blades moves relative to the frame to lift one side of the incision above the other, thereby facilitating a variety of surgical procedures, including, for example, accessing the underside of the chest wall to harvest the right or left internal mammary artery, repair or replacement of the mitral and aortic valves, proximal anastamosis of arterial conduits to the aorta and distal anastamosis of the conduits to coronary arteries, and any of various other procedures requiring access to the heart, great vessels, lungs, or other thoracic contents.
According to one specific preferred embodiment, at least one of the retractor blades is coupled to the frame so as to be rotatable with respect thereto about a second axis which is generally perpendicular to the first axis. The actuator moves the blades apart which, due to the foot acting a support base, causes the one blade to rotate with respect to the frame, such rotation occurring in a direction that lifts the side of the incision engaged by the rotating blade.
According to another specific embodiment, the foot preferably is movable with respect to the frame to permit adjustment of the relative position of the foot and the frame, such adjustment occurring along a third axis which is transverse, and preferably perpendicular to the first and second axes.
According to yet another specific embodiment, one of the retractor blades is rotatable about a second axis with respect to the frame and is coupled thereto so as to be movable between rotatable and non-rotatable positions. Locating the retractor blade in the non-rotatable position configures the retractor for spreading of the ribs (i.e., without lifting), while locating the blade in the rotatable position configures the retractor for lifting and spreading of the ribs.
A method of retracting a portion of a patient""s body according to the invention comprises steps of positioning first and second retractor blades against opposite sides of an incision formed in a patient""s body, the retractor blades being coupled to a frame so as to be relatively movable toward or away from each other along a first axis, and providing a foot configured to contact a surface of the patient""s body adjacent the incision, the foot being coupled to the frame so as to be adjustable with respect thereto along a direction which is transverse to the first axis. The position of the foot is adjusted with respect to the frame to place the foot against the surface of the patient""s body adjacent the incision, and relative movement is imparted to the first and second blades to simultaneously move the blades apart along the first axis and lift one side of the incision with respect to the other side of the incision.
Other features, benefits and advantages of the invention will become apparent from the following detailed description of preferred embodiments thereof, taken in conjunction with the accompanying drawing Figures.